An exhibition from the Antony Wallace Archive of BAPRAS

20 Pages·2015·1.01 MB·English

An exhibition from the Antony Wallace Archive of BAPRAS
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Portrait of Private Walter Ashworth (1916), by Henry Tonks (1862-1937)
RCSSC/P 569.50
Courtesy of the Hunterian Museum at the Royal College of Surgeons of England
FOREWORD
The meeting of the European plastic and reconstructive surgeons so close to the
outbreak of the First World War set BAPRAS and its Antony Wallace Archive to
thinking about the development of the specialty brought about by the conflict. There
is ample information available from Sir Harold Gillies’ papers and the clinical notes
rescued from the Queens Hospital at Sidcup on the early days of plastic surgery in
Britain. However our knowledge of the situation across the Channel is deficient.
This exhibition, A Strange New Art, is intended to display what we know, stimulate
discussion and collect information, particularly from the Continent about this
important time for plastic and reconstructive surgery.
Brian Morgan
Honorary Archivist, Antony Wallace Archive (BAPRAS)
Exhibition curated by Kristin Hussey (Assistant Curator)
and Brian Morgan (Honorary Archivist)
Written by Kristin Hussey
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INTRODUCTION
This was a strange new art, and unlike the student today, who is
weaned on small scar excisions and gradually graduated to a single
harelip, we were suddenly asked to produce half a face.
Harold Gillies, The Principles and Art of Plastic Surgery (1957)
Plastic surgery techniques have been in use for over 2,000 years, however it was not
until the First World War (1914–1918) that these practices were brought together
as a distinct specialty. Mechanised conflict on a global scale resulted in traumatic
facial injuries never before encountered by surgeons. Peering over the trenches with
only tin helmets for protection, maxillofacial injuries were rife amongst soldiers on
all sides. It has been estimated that 60,500 British soldiers suffered head and eye
injuries and over 460,000 French soldiers received facial injuries. Jaws torn apart
by shrapnel and rifle bullets tested the skills of clinicians from frontline medics to
dental surgeons.
To tackle these injuries, a new
generation of surgeons rose to the
challenge of reconstructing disfigured
faces. Sir Harold D Gillies (1882–1960),
remembered as the founder of British
plastic surgery, recalled this era as the
time when ‘a strange new art’ known as
plastic surgery was born. However Gillies
was not alone in his pioneering work. He
was particularly influenced by the work
of European surgeons such as Hippolyte
Morestin (1869–1919), Charles Auguste
Valadier (1873–1931), and JF Esser
(1877–1946). From Berlin to Lyon, Sidcup
to Paris, facilities were established
to tackle the influx of facial and jaw
Portrait of Private Edward Moss (1918)by
Henry Tonks (1862–1937). Courtesy of the injuries. This exhibition draws on the
Hunterian Museum at the Royal College of collections of the Antony Wallace Archive
Surgeons of England, RCSSC/P 569.29 at the British Association of Plastic,
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Two Canadian wounded,
heavily bandaged, being
removed by motor
ambulance from the
Battle of Passchendaele,
1917. Courtesy of the
Imperial War Museums
(IWM), IWM: CO 1636
Reconstructive and Aesthetic Surgeons (BAPRAS) to examine the development of
plastic surgery during this era in the United Kingdom and Europe. By considering
the contributions and experiences of clinicians, patients, and technicians, A Strange
New Art seeks to explore the historical and human context surrounding the birth of
plastic surgery.
The exhibition is divided into five central themes: Patients, Clinicians, Technicians,
Britain and Europe. The Patients display considers the experiences of soldiers
with facial injuries during the war and displays reproduction documents from
Gillies’ case files alongside instruments which would have been used to carry out
reconstructions in this era. This case is complemented by reproductions of the
famous pastel portraits by Professor Henry Tonks housed in the Royal College of
Surgeons of England. The Clinicians case explores the role of individuals in the
development of the specialty, particularly Harold Gillies, Jacques Joseph and dental
surgeon William Kelsey Fry. The Technicians section acknowledges the important
contributions of the non-surgical staff that supported plastic surgeons in their
work. From dental technicians to radiologists and artists, this display focuses on
the wider contributions of the medical community. The theme of Britain examines
the development of plastic surgery in the UK from the Cambridge Military Hospital
in Aldershot to the famous Queen's Hospital at Frognal House in Sidcup. Finally the
Europe display seeks to highlight the important contributions of European surgeons
and reconstructive units in the development of plastic surgery internationally.
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PATIENTS
Men without half their faces; men burned and maimed to the
condition of animals. Day after day, the tragic, grotesque procession
disembarked from the hospital ship and made its way towards us.
Harold Gillies, The Principles and Art of Plastic Surgery (1957)
On 1 July 1916, one of the bloodiest battles in history began on the banks of the Somme
River in France. In what came to be known as the Somme Offensive, over 1,000,000
men were wounded or killed between the opening day and 18 November. On the first
day of the Offensive, Private Walter Ashworth, a 23-year-old in the 18th West Yorkshire
Regiment, received a gunshot wound which destroyed much of the soft and bony tissues
of his face. That same day, elsewhere at the Front, Private Charles Deeks suffered an
explosive wound to his right cheek that also deformed both his upper and lower lips. Two
days later, Deeks arrived at the Cambridge Military Hospital in Aldershot for treatment
under Captain Harold Gillies and his new plastic unit. Ashworth followed on 5 July.
The Queen’s Hospital Football Club, 1921-1922. From the Antony Wallace Archive of
the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS)
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Gillies recorded that the Somme Offensive sent his unit approximately 2,000 patients;
it had been expecting 200. However, it was only the fortunate who made it as far as
Aldershot. Sudden haemorrhage and airway obstructions from travel conditions
could kill a soldier with a facial injury instantly. Gangrene and infections caused by the
bacteria-rich dirt of the trenches were a battle against which surgeons of the time had
almost no defence. Yet even the patients who survived their operations still had cope
with the emotional trauma of disfigurement.
Gillies was keen that soldiers with facial injuries were rehabilitated. Part of the motive
for the unit’s relocation to Frognal House in Sidcup was to provide room for patients
to recuperate in between procedures. Sidcup offered training to its patients so they
could return to civilian life with skills such as toy-making, cinema operating and watch
repairing. However, some trades taught were intended to ensure that the disfigured
soldiers could be hidden from society. Mirrors were forbidden from the wards to keep
patients from seeing the extent of their injuries. Although the staff worked to keep up
spirits, facial disfigurement could lead to despair: patients often refused to see their
families and loved ones. Set away from the general
populace, Sidcup served to heal the wounded but also to
protect the public from the sight of the facially wounded.
Ashworth and Deeks arrived within days of each other
at Gillies’ plastic unit at Aldershot. Did they meet? Did
they strike up a friendship on the ward? Deeks was the
first to be discharged on 19 April 1917 while Ashworth
would need to wait until 26 September. Though Deeks
would have been discharged too early, Ashworth moved
to the new Queen’s Hospital at Sidcup in August 1917.
Only a few accounts survive of the experience of patients
in the plastic wards of the First World War. Ashworth
went on to work as a tailor although he later recalled
facing prejudice as a result of his disfigurement. After Private Charles Deeks
his discharge he was left by his fiancée, however, he later on admission to the
Cambridge Military Hospital,
married her best friend and emigrated to Australia.
Aldershot, 1916. From
the Archives of the Royal
College of Surgeons of
England, MS0513/1/1/553
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CLINICIANS
It being a rather informal war, the enemy did not seem to mind our learning of
the good work they were doing on jaw fractures and wounds of the mouth.
Harold Gillies, The Principles and Art of Plastic Surgery (1957)
The year is 1915 and Hippolyte Morestin is leaning over a patient in the operating
theatre of the Val-de-Grâce Hospital in Paris. He is eagerly watched by a young
surgeon from New Zealand, Harold Gillies. In a swift movement, Morestin deftly
moves a flap from the neck to cover the deficiency created by the cancerous tumour
he has just removed. Gillies was fascinated by Morestin’s skilled work of rebuilding
the face with an artistic touch. Although he is remembered as the founder of
British plastic surgery, Harold Gillies drew extensively on the work of his fellow
clinicians. In 1916, Gillies was granted a war permit to travel around France and
study the work being done with reconstructions. While such procedures were new
to the United Kingdom, Europe had a more established generation of practitioners,
including Jacques Joseph (1865–1934), a pioneer in cosmetic rhinoplasty, working
at the Charité Hospital in Berlin. Just as Britain worked to open its first plastic unit,
German surgeon August Lindemann (1880–1970) was already attempting to improve
the front line care received by soldiers with facial injuries through his publications.
Without any established training in plastic surgery, practitioners came from a variety
of backgrounds. Gillies himself trained as an otolaryngologist and was introduced to
facial reconstruction by French-American dentist Charles Valadier. Perhaps due to
a shared focus on the facial region, many early clinicians working in reconstruction
were dentists or dental surgeons. Indeed much of the pioneering work done early in
the war was by dental specialists at the jaw hospital in Düsseldorf. In the time before
maxillofacial surgery was established, dental and plastic surgeons worked closely
together to repair hard and soft tissues. As Gillies’ collaborator William Kelsey
Fry wrote in 1917, ‘Neither the dental aspect is neglected by Major Gillies, nor the
surgical aspect by myself, and the reconnaissance into the other man’s territory has
led to the closest cooperation between us working as a team and we believe with
satisfactory results.’
Gillies is perhaps most remarkable for his enthusiasm and ability to bring together
new ideas and talented clinicians to create a centre for the new discipline at Sidcup.
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The centralisation of plastic surgery
procedures in Britain at the Queen’s
Hospital had the added benefit of
establishing a hub for training under
Gillies and his team. Surgeons from
America, Canada, Australia and New
Zealand came together at Sidcup to
experience the new specialty. Throughout
this enterprise, Gillies was supporting
by his commanding officer, Sir William
Arbuthnot Lane (1956–1943), who was
instrumental in the organisation of the
hospital. With the space to focus on
facial reconstructions, Gillies and his
colleagues soon developed their own
unique styles and approaches.
Innovation spread even to the
instruments used in the new operations.
Gillies himself invented the combined
needle holders and scissors which
bear his name today. Working closely
with dental surgeons and technicians,
plastic specialists required creativity and
patience to treat each distinct case.
Portrait of Harold Gillies (1882–1960)
as a medical officer, c.1915. From the
Antony Wallace Archive of the British
Association of Plastic, Reconstructive
and Aesthetic Surgeons (BAPRAS)
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The Officers of the Queen’s Hospital, Sidcup, 1917. From the Antony Wallace Archive of
the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS)
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